Statement on World Aids Day 2016 December 1st

Over 2,400 people living with HIV infection are estimated to live in Lebanon (1). Stigma and discrimination towards this population, as a consequence of their HIV status, result in significant negative consequences on their health and wellbeing (2) (3) (4). These issues affect a lot of people living with HIV in Lebanon and play an important obstacle for HIV treatment and prevention in Lebanon today.

Stigma towards people with HIV in Lebanon exists for a number of reasons. Inaccurate information regarding HIV transmission fosters irrational beliefs and behaviours, resulting in a poor perception of personal risk (4). HIV continues to be associated with societal taboos such as sex work, illicit intravenous drug use, and in particular, homosexuality. Negative attitudes towards homosexuality are common in much of the Lebanese society. Furthermore, men who have sex with men (MSMs) account for over half of cases of recent HIV infection in Lebanon (5). Legal discrimination as well as harassment and violence against gay men and transwomen is known to deem these groups more vulnerable worldwide. Article 534 of the Lebanese Penal code, which criminalizes sexual acts “contrary to nature” along with recent arrests and harassment of gay men in the country also deters potentially play a similar role in Lebanon and prevent also deters many MSMs from seeking HIV testing and treatment as they fear legal repercussions as a result of disclosing their sexual behaviours to health workers (6). Additionally, the World Health Organisation, for example, states that fear of discrimination and stigma is the principal reason deterring individuals from getting tested, disclosing their HIV status and taking antiretroviral therapy (7). Information on the infection of transwomen with HIV is not included in data that is presented by the National AIDS program in Lebanon.

Access to healthcare for people living with HIV in Lebanon poses a considerable challenge. Whereas anti-retroviral medications and HIV testing may be obtained free of charge, significant barriers exist to obtaining long-term HIV treatment (6). Patients who test positive for HIV fear that their diagnosis will not remain confidential and thus that this diagnosis will have profound negative implications for other areas of their life (2). Case reports exist of individuals who lost their medical insurance and job as a result of their HIV diagnosis (8). The stigma associated with the virus increases further the fear of individuals who test positive for HIV of seeking treatment or even having it in their households.

Sexual education is missing in all health related curricula in Lebanon and health care workers rarely discuss sexual concerns with clients. As a result, stigma against people with HIV is also common amongst health workers. Such stigma includes avoiding patients with HIV, refusing to treat them, breaking their confidentiality or indeed treating them with any less care or concern than any other patients. In many cases, these behaviours are complicated by discriminatory attitudes and actions towards HIV+ patients who are LGBT+, drug-users or of foreign origin. Such beliefs act as a further deterrent to health care access, worsening these patients’ health and wellbeing.

On World AIDS Day 2016, the Lebanese Medical Association for Sexual Health calls for:

Better documentation of people living with HIV in order to make sure interventions are affecting people who need it the most. Particularly LebMASH calls on including transgender populations in national HIV data presented.

Better education about HIV targeting health providers, the broad public and government workers.

Increase education among health workers and the general public on the virus and how it affects specific vulnerable groups

Further research and understand the epidemic in Lebanon and how to face it from a social and medical stand-point.

Advocate for implementation of accurate treatment and prevention guidelines, particularly when it relates to treatment as prevention with treatment ensured to anyone living with HIV to both increase their longevity as well as prevent the transmission of the virus.

Are HIV Epidemics among Men Who Have Sex with Men Emerging in the Middle East and North Africa?: A Systematic Review and Data Synthesis. Mumtaz G, Hilmi N, McFarland W, Kaplan RL, Akala FA, et al. 2011, PLoS Med , p. 8(8): e1000444.